Postpartum Depression

When a new baby is on the way or has just been born, most people expect moms to be happy and joyous. Yet for many women, childbirth brings on an unexpected mood — depression. We call such episodes of sadness “postpartum depression,” even though the depressive episode can also start before the child’s birth. Postpartum depression is experienced most often by mothers either during or after childbirth (although it can affect fathers as well).

If your post-birth baby blues don’t resolve on their own within two weeks after the birth of your child, it’s possible you may have something more than just normal “baby blues.” Postpartum depression is a serious, debilitating illness that mothers have no control over. Like all types of depression, this is not the result of a character flaw, weakness, or anything the mom has done. Instead, it is a serious mental illness that needs attention and treatment.

How Postpartum Depression is Diagnosed

Postpartum depression is classified in the DSM-5 as Bipolar Disorder or Depression with Peripartum Onset. A person suffering from postpartum depression has to meet these symptoms of a major depressive episode. Postpartum depression is diagnosed when the depressive episode occurs before or after the birth of the person’s child.

Sometimes a person with postpartum depression may believe they are just suffering from the normal “baby blues” after giving birth. But postpartum depression symptoms last longer than the baby blues and are usually more intense. Depression impacts your ability to carry out everyday activities, and will even prevent a new mom from caring for their baby. Postpartum symptoms usually develop within the first few weeks after giving birth, but may begin later — up to six months after birth.

Some new moms (or dads) may experience the following postpartum depression symptoms also:

Depressed mood or severe mood swings

Excessive crying

Difficulty bonding with your baby

Fear that you’re not a good mother

Overwhelming fatigue or loss of energy

Withdrawing from family and friends

Problems with appetite (loss of appetite or eating more than usual)

Problems with sleep (problems falling asleep or sleeping too much)

Reduced interest and pleasure in activities you used to enjoy

Intense irritability or irrational anger

Feelings of worthlessness, shame, guilt, or inadequacy

Difficulty in thinking clearly, concentrating, or making decisions

Severe anxiety or panic attacks

Thoughts of harming yourself or your baby

Thoughts of death or suicide

It is thought that between 3 and 6 percent of women will experience major depressive symptoms during pregnancy or in the weeks or months following delivery. Women who have a preexisting history of symptoms of bipolar disorder or depression have a higher likelihood of experiencing mood disturbances during and/or after pregnancy.

Fifty percent of “postpartum” major depressive episodes actually begin prior to delivery. Thus, these episodes are referred to collectively as peripartum episodes in the DSM-5.

Women with peripartum major depressive episodes often have severe anxiety and even panic attacks during the peripartum period. Moreover, studies examining women pre-to-post-pregnancy demonstrate that those with anxiety or the “baby blues” during pregnancy are at increased risk for postpartum depression.

Mood episodes during postpartum depression can present either with or without psychotic features. Most women who have postpartum depression do not have psychotic features. The risk of postpartum episodes with psychotic features is particularly increased for women with a pre-existing mood disturbance (especially bipolar I disorder), a previous psychotic episode, and those with a family history of bipolar disorders. There can be some rare but extreme events associated with postpartum depression with psychotic features.1

Major Depressive Episode Symptoms

A person who suffers from a major depressive episode must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person’s normal mood. In addition, the person’s social, family, work, or school functioning must also be negatively impaired by the change in mood.

Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.)

Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day

Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day

Psychomotor agitation or retardation nearly every day

Fatigue or loss of energy nearly every day

Feelings of worthlessness or excessive or inappropriate guilt nearly every day

Diminished ability to think or concentrate, or indecisiveness, nearly every day

Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Footnotes

Infanticide (killing one’s infants) — an extremely rare event that has been publicized in the news from time to time — is most often associated with postpartum psychotic episodes that are characterized by command hallucinations to kill the infant or delusions that the infant is possessed. However, psychotic symptoms can occur absent of such specific delusions or hallucinations. [↩]

John M. Grohol, Psy.D.

Dr. John Grohol is the founder, Editor-in-Chief & CEO of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Computers in Human Behavior and is a founding board member and treasurer of the Society for Participatory Medicine. He writes regularly and extensively on mental health concerns, the intersection of technology and psychology, and advocating for greater acceptance of the importance and value of mental health in today's society. You can learn more about Dr. John Grohol here.